Widely-available drug could reduce deaths from head injury

18 October 2019

A low cost and widely available drug could reduce deaths in traumatic brain injury patients by as much as 20 per cent depending on the severity of injury, according to a major study carried out a number of centres including the Queen Elizabeth Hospital Birmingham (QEHB).

The research, published in The Lancet, showed that tranexamic acid (TXA), a drug that prevents bleeding into the brain by inhibiting blood clot breakdown, has the potential to save hundreds of thousands of lives.

The CRASH-3 (Clinical Randomisation of an Antifibrinolytic in Significant Head Injury) trial was one of the largest clinical trials ever conducted into head injury, with patients recruited from 175 hospitals across 29 countries.

The trial results found that administering tranexamic acid intravenously within three hours of injury reduced the number of deaths, with the effect greatest on patients with mild and moderate traumatic brain injuries.

Co-investigator for trial Professor Tony Belli, Director of the NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), said: “This is a landmark study. After decades of research and many unsuccessful attempts, this is the first ever clinical trial to show that a drug can reduce mortality after traumatic brain injury.

“Not only do we think this could save hundreds of thousands of lives worldwide, but it will no doubt renew the enthusiasm for drug discovery research for this devastating condition.”

Ian Roberts, Professor of Clinical Trials at the London School of Hygiene & Tropical Medicine, who co-led the study, added: “We already know that rapid administration of tranexamic acid can save lives in patients with life threatening bleeding in the chest or abdomen such as we often see in victims of traffic crashes, shootings or stabbings.

“This hugely exciting new result shows that early treatment with TXA also cuts deaths from head injury. It’s an important breakthrough and the first neuroprotective drug for patients with head injury.

Because TXA prevents bleeds from getting worse, but cannot undo damage already done, early treatment is critical. The trial data showed a 10% reduction in treatment effectiveness for every 20-minute delay, suggesting that patients should be treated with TXA as soon as possible after head injury.

The trial was jointly funded by the Department for International Development (DFID), the Medical Research Council (MRC), the National Institute for Health Research (NIHR) and Wellcome.